This document provides an overview of diseases of the salivary glands. It begins with an introduction to the major and minor salivary glands. It then discusses specific diseases including sialadenitis (inflammation of the salivary glands), which can be caused by viral infections like mumps or bacterial infections. Other conditions covered include sialolithiasis (salivary stones), Sjogren's syndrome, and various cysts and tumors that can affect the salivary glands. For each condition, the document provides details on causes, clinical features, investigations, and treatments.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Inflammatory n infectious diseases of salivary gland- Dr Sanjana RavindraDr. Sanjana Ravindra
SALIVARY GLAND
Introduction
Classification
Composition of saliva
Properties of Saliva
Functions of Saliva
Salivary gland examination
Classification of Salivary gland diseases
INFLAMMATORY and INFECTIOUS DISEASES OF SALIVARY GLAND
Introduction
Classification
Various diseases
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Inflammatory n infectious diseases of salivary gland- Dr Sanjana RavindraDr. Sanjana Ravindra
SALIVARY GLAND
Introduction
Classification
Composition of saliva
Properties of Saliva
Functions of Saliva
Salivary gland examination
Classification of Salivary gland diseases
INFLAMMATORY and INFECTIOUS DISEASES OF SALIVARY GLAND
Introduction
Classification
Various diseases
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
An Autoimmune Disease : Sjogren's Syndrome, also known as Sicca Syndrome was described by Dr. Henrik Sjogren. It is a triad of Dry eyes, Dry mouth & Rheumatoid Arthritis. The presentation provides a guide to the students regarding the disease including Types, History, Epidemiology, Etiopathogenesis, Clinical features, Systemic & Oral manifestations, Diagostic criteria, Histopathological features, Serological findings, Radiography & Salivary gland imaging (involving sialography, scintigraphy, sonography & MRI), its Treatment along with the advancements in treatment, Complications & Prognosis.
Presentation by - Dr.Harsimran Singh Kapoor
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. Introduction
The salivary glands classified as major&
minorglands
Major glands are paired glands they are
Parotid glands
Submandibular glands
Sublingual glands
The numerous minor salivary glands , widely
distributed in the oral cavity
Salivary gland secretion contain water,
electrolytes , urea , ammonia , glucose , fats
&proteins
2
3. Parotid gland
Largest salivary gland
Pyramidal in shape
Two lobes superficial , & deep connected by
an isthmus at posterior part of gland
Apex is toward angle of mandible
Base at the external acoustic meatus
Anteriorly gland extends up to buccal pad of
fat
Posteriorly encircles posterior border of
mandible
Parotid gland secretion is serous in nature
3
4. Parotid duct (Stenson's duct )
Stenson`s duct emerges at anterior part of
gland
Stenson`s duct opening is seen as a papilla in
the buccal mucosa opposite maxillary second
molar
4
5. Submandibulargland
The gland is located submandibular space
Extending inferiorly up to digastric muscle
Superiorly mylohyoid muscle
Posteriorly up to angle of mandible
Anteriorly mid portion of body of the mandible
Submandibular gland secretion is mixed
5
6. Submandibularduct (Wharton's
duct)
The duct starts from deep part of gland
Turns sharply at the posterior border of
mylohyoid muscle anteriorly & superiorly ,
crosses hyoglossus muscle
6
7. Sublingual gland
This gland is located in sublingual space it is
present in association with sublingual fold
below tongue , & divided into anterior &
posterior part
Sublingual gland secretes both serous &
mucous
Bartholin’ s duct
The ducts of anterior part may join to form a
large main duct called Bartholin’ s duct
7
8. Minorsalivary glands
More than 800 minor salivary glands may be
present in oral cavity
Secrete mucous secretions
8
9. Functions of saliva
Digestive function
Protective function
Cleansing
Lubrication
Antibacterial action
9
14. Xerostomia
Xerostomia is a subjective sensation of a dry
mouth
It affects women more than men , are
commonly in older people
Antihistamines , decongestants ,
antidepressants , antipsychotics,
antihypertensives, & anticholinergics are
known to cause xerostomia
Other cause of xerostomia -- salivary gland
aplasia, aging , excessive smoking , mouth
breathing , local radiation therapy , Sjogren’s
syndrome & HIV infection
14
15. Cont.
Clinical features
Dry mouth with foamy , thick , & ropy saliva
Gloves stick to the mucosa
Difficulty in mastication & swallowing
More chance for candidiasis & caries
Treatment
Removal of the cause
Maintenance oral hygiene
Use of sialagogues
15
17. Sialorrhoea
Sialorrhoea is excessive salivation
Minor sialorrhea can be seen due to local
irritation like aphthous ulcers or ill- fitting
dentures
Profuse salivation is seen in rabies, heavy
metal poisoning, gastro esophageal reflux
disease or after certain medication like lithium
& cholinergic agonists
Mentally retarded children also excessive
salivation – not by excessive production of
saliva
Treatment
Removal of the cause
17
19. Sialadenitis
Inflammation of the salivary glands is known
as sialadenitis
Causes
Viral infections
Bacterial infections
Allergic reactions
Systemic diseases
19
20. Mumps
It is also called as epidemic parotitis.
It is caused by paramyxo virus and affects
major salivary glands, especially the
parotid salivary gland.
Clinical Features:
The mumps virus can be transmitted through
urine, saliva or respiratory droplets.
Incubation period-16 to 18 days.
20
21. Cont.
Patients are contagious 1 day before & 14
days after the resolution
Usually subclinical
If symptomatic prodromal symptoms of Low-
grade fever, Headache, malaise & Myalgia
Discomfort & swelling over the lower ½ of
external ear down to posterior & inferior
border of mandible
Either one or both the parotid gland are
enlarged and become tender.
21
22. Cont.
Enlargement & pain are maximum in 2-3 days
Chewing movements or saliva stimulating
foods increases pain
Enlargement begins on one side & then
extends to other side
There many also be and edema & erythema
involving the ductal orifice.
If sublingual gland is involved – bilateral
enlargement of floor of mouth
22
25. Bacterial infection
Bacterial infection can inflammation of major
salivary glands
Bacterial sialadenitis affects parotid gland
more commonly
Submandibular glands are rarely affected
25
26. Acute bacterial sialadenitis
Organisms - staph ;aureus , strep ; pyogenes,
strep; viridans etc
Some drugs like tranquilizers; antiparkinson
drug ; diuretics; & antihistamines drugs etc
decrease salivary flow with increased chance
of infection of salivary glands
Clinical features
Sudden onset of pain at angle of the jaw
which is unilateral
26
27. Cont.
Affected gland is enlarged & tender &
extremely painful
Inflammatory swelling is very tense & does not
show much fluctuation
Skin is warm & red
Associated fever & trismus may be there
Purulent discharge from the affected duct
orifice
Histopathologic features
Accumulation of neutrophils is observed
with in ductal system & acini
27
28. Cont.
Treatment
Antibiotics
Hydrating the pt
Stimulate the salivation by chewing
sialagogues
Improve oral hygiene by debridement &
irrigation
Surgical drainage if abscess is there
28
29. Chronic bacterial siladenitis
It may be idiopathic or with factors like
Duct obstruction ,
Congenital stenosis,
Sjogren ’s syndrome
The microorganisms may be strep; viridans, e-
coli
Clinical features
Unilateral periodic pain & swelling at the angle
of jaw usually during mealtime
Gland may undergo atrophy , which results in
decreased salivary flow
29
30. Cont.
Histopathologic features
Patchy infiltration of salivary parenchyma
by lympocytes & plasma cells
Atrophy of acini & ductal dialatation &
sometimes fibrosis
Sialography – ductal dialatation proximal to
area of obstruction
Treatment
Antibiotics
30
31. Cont.
Intra ductal infusion of erythromycin or
tetracycline
Excision of the gland
31
33. Sjogren syndrome
Characterized by dry eyes , xerostomia &
rheumatoid arthritis
Clinical features
Occurs predominantly in women
Dry eyes & dry mouth
Pain & burning sensation
Red & tender mucosa with Ulceration
Difficulty in swallowing
Altered taste sensation
Denture sore mouth
33
34. Cont.
Angular cheilitis
There may have diffuse firm enlargement of
major salivary glands usually bilateral
Sialography- demonstrates cavitary defects
are filled with radiopaque contrast media
producing ‘ branchless fruit laden tree’ or
“cherry blossom appearance”
Histopathologic features
Lymphocytic infiltration with destruction of
acinar cells
34
37. Sialadenosis
It is non- inflammatory , non - neoplastic
swelling of the salivary gland
Sialadenosis can occur in the following
conditions;
Hormonal disorders(pregnancy, hypothyroidism)
Diabetes mellitus
Alcoholic cirrhosis
Malnutrition
Caused by dysregulation of autonomic
innervation of salivary acini causing aberrent
intracellular secretory cycle leading to
excessive secretion of secretory granules
37
38. Cont.
Clinical features
Enlargement is usually painless
Usually bilateral
More common in women
Commonly affects parotid
Histopathologic features
Hypertrophy of acinar cells
Nuclei are displaced to the base
Cytoplasm is engorged with zymogen
granules
38
39. Cont.
In DM & alcoholism – acinar atrophy & fatty
infiltration
Treatment
Control underlying cause
Pilocarpine
39
40. Sialolithiasis
Sialolithiasis is the formation of sialolith
( salivary calculi, salivary stone ) in the salivary
duct or gland resulting in the obstruction of the
salivary flow
Sialolith
Sialolith is a calcified mass with laminated
layers of inorganic material from crystallization
of salivary solutes
The sialolith is yellowish white in colour ;
Single or multiple, may be round & ovoid or
elongated having size of 2cm or more
diameter
40
41. Cont.
The minerals are various forms of calcium
phosphate like hydroxyapatite, octacalcium
phosphate etc
Calcium & phosphorus ions are deposited on
the organic nidus, may be desquamated
epithelial cell, bacteria, foreign particle or
product of bacterial decomposition
It may be related to sialadenitis or ductal
obstruction
Clinical features
Commonly seen in middle -age persons
41
43. Cont.
More common in submandibular salivary ductal
system
Pain & swelling during & after eating food
Stone can be palpated if it is in the peripheral
aspect of the duct
Minor salivary stones are seen as
asymptomayic hard nodule commonly in upper
lip
Histopathologic features
Sialoliths appear as round , & oval calcified
mass exhibits concentric laminations surround
a nidus of amorphous debris43
44. Cont.
Investigations
Radiographs –PA view , lateral oblique or
occlusal view – shows radiopaque mass
Sialography
Treatment
Smaller sialoliths, are located peripherally
near ductal opening may be removed by
manipulation called milking the gland
Larger sialoliths are surgically removed
44
45. Cont.
Stones which are not impacted , may be
extracted through the intubation of the duct
with fine soft plastic catheter& application of
the suction to the tube
Piezoelectric shock wave lithotripsy
Multiple stones or stone in gland require
removal of the gland
Transoral sialolithotomyof thesubmandibular
duct
Local anaesthesia
Position of the stone is located by x-rays &
palpation
45
46. Cont.
Suture is placed behind the stone
Tongue is lifted & held with help of a gauze
Incision is made in the mucosa parallel to the duct
Duct is located by blunt dissection
Longitudinal incision is made over the stone
Stone removed using small forceps, in case the
stone is large, it is crushed with help of the
forceps
Cannula may be passed to aspirate the pieces of
stone, mucin etc
Sutures are placed at the level of the mucosa
46
47. Mucocele
Lower lip is commonly affected
Other common sites are buccal mucosa,
ventral tongue, floor of mouth
It can be superficial or deep
Superficial – elevated well circumscribed
vesicle with bluish hue
Deep – nodule with no change in color
Cystic contents – thick mucous material
Usually covered by mucous membrane
There may have periodic rupture of the
swelling releasing the contents47
49. Cont.
After rupture it may leave shallow painful
ulcers
Some lesions resolve by itself
Histopathologic features
Area of spilled mucin surrounded by granulation
tissue
Adjacent minor salivary glands contain c/c
inflammatory infiltrate
Treated by excision along with adjacent minor
salivary glands to prevent recurrence
49
50. Salivary duct cyst
Mucus retention cyst or sialocyst
Epithelium lined cavity that arises from salivary
gland tissue
True cyst
May be caused by ductal dilatation or
secondary to ductal obstruction
It can be seen in major or minor salivary
glands
Cysts of major glands are common in parotid
gland
Intraoral cyst are common in buccal mucosa,
floor of mouth & lips
50
51. Cont.
They are soft, fluctuant, asymptomatic swelling
& may appear bluish depending on the depth
Histopathologically – cyst may be lined by
cuboidal, columnar or squamous epithelium
surrounding the mucoid secretion in lumen
Treated by local excision for minor salivary
gland ducts
For major salivary glands total or partial
removal of gland can be done
Sialgogues can stimulate salivation & prevent
accumulation of mucus
51
53. Ranula
Extravasation cyst usually arises from ducts of
sublingual gland
Bluish, dome shaped, fluctuant swelling in
floor of mouth
May enlarge raise the tongue
Usually seen lateral to midline
May extend to the neck behind the posterior
border of mylohyoid (plunging ranula)
Histopathologically similar to mucocele
Treated by marsupialization or removal of the
feeding sublingual gland53
55. Pleomorphic adenoma
It can affect both major & minor salivary gland
It commonly affects the parotid gland
Clinical features
More commonly in females
Small painless nodule at the angle of
mandible or beneath the ear lobe
Well circumscribed , encapsulated , firm in
consistency & may show area of cystic
degeneration
Difficulties in mastication & talking
Initially tumor is movable but later becomes55
56. Cont.
If deep lobe is affected , a swelling in the
lateral pharyngeal wall or soft palate
Minor salivary gland involvement is common in
palate & lip as smooth surfaced dome shaped
swelling
Histopathologic features
Well - circumscribed , encapsulated tumor
Tumor is composed of a mixture of glandular
epithelium & myoepithlial cells with in a
mesenchyme like background may be myxoid
or chondromatous or hyalinized56
59. Warthin tumor
Papillary cystadenoma lymphamatosum
Affects the parotid glands
Males are affected more
Clinical features
Firm or fluctuant, non- tender , circumscrided
mass in the region of angle or ramus of the
mandible or beneath ear lobe
Common in the tail of the gland
Both side parotid gland affected
59
62. Mucoepidermoid carcinoma
The low grade tumour behaves almost like a
benign tumour with very good prognosis
High grade tumour behaves very aggressively
It occurs with equal distribution between
males& females
Clinical features
More common in parotid gland
It may grow slowly or rapidly
Painless swelling
Ulceration
62
63. Cont.
Facial paralysis
Minor salivary gland tumors are common in
palate & may have bluish hue
Local destruction & metastasis to regional
lymph nodes & distant metastasis to the lung
Histopathologic features
Mucus producing cells & squamous cells
High grade tumors have cellular atypia
63
65. Cont.
Treatment
Surgical excision
For minor salivary glands excision with
surrounding normal tissues
For tumors with metastasis radical resection
with radiation
65
66. Acinic cell carcinoma
A low grade malignancy
Clinical features
Commonly occurs in parotid gland
Common in females
Usually asymptomatic
Commonly affects serous acini
In minor salivary glands it is common in buccal
mucosa, lip & palate
It may be a slow growing swelling
Sometimes pain, tenderness may be there
66
68. Cont.
Histopathologic features
Acinar cell has abundant granular basophilic
cytoplasm & round, darkly stained eccentric
nucleus
Treatment
Tumour confined to the superficial lobe is
treated by lobectomy
Tumour involving deep lobe - parotidectomy
Radiotherapy for severe cases
68
69. Adenoid cystic carcinoma
It is also called cylindroma
Clinical features
Slow growing swelling
Commonly occurs in palatal minor salivary
glands
Commonly occurs in middle aged individuals
Constant , low grade, dull aching pain
Facial nerve paralysis in parotid tumours
Histopathologic features
Islands of basaloid epithelial cells that contain
multiple cylindric , cyst like spaces
69
72. Necrotizing sialometaplasia
It is a locally destructive inflammatory lesion
affecting minor salivary glands
Cause is ischemia of salivary tissues
Clinical features
Commonly occurs in men
Minor salivary glands of the palate, lip or
retromolar pad affected
The lesion occurs as a swelling with
paresthesia then it sloughs leaving large ulcer
or ulcerated nodule
Edge of lesion presents with an inflammatory72
74. Cont.
Histopathologic features
Acinar necrosis
Squamous metaplasia of salivary ducts
Treatment
Debridement by hydrogen peroxide or saline
Application of gentian violet
The lesion is self - limiting one & heals in 6 to
8 weeks
74
75. Sialography
It is a specialized radiographic procedure
performed for detection of disorders of major
salivary glands
Mercury is used as contrast agent
It involves cannulation & filling with a
radiopaque or contrast agent to make them
visible on a radiograph
Indications
Detection of calculi or foreign bodies
75
76. Cont.
Determination of the extent of destruction of
salivary gland tissue secondary to obstruction
such as calculi or foreign bodies
Detection of fistulae , diverticuli & strictures
Detection & diagnosis of recurrent swelling &
Inflammatory processes
Demonstration of tumour ; its size location &
origin
Selection of the site for biopsy
76
77. Cont.
Contraindications
Pt with allergy or hypersensitivity to contrast
media
Acute inflammation of the salivary glands
Pt scheduled for thyroid function test
Technique
Identification of the location of duct orifices
Exploration of the duct with lacrimal probe
Cannulation of the ducts
Introduction of the radiographic dye
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80. Superficial parotidectomy
Indications
Tumour ; common is pleomorphic adenoma
Massive enlargement secondary to
Sjogren’s syndrome
Calculus in the hilum of gland - calculus is
removed without removal of the gland
Chronic infection
80
81. Cont.
Approaches
Preauricular
Submandibular
Combination of the two
Preauricularincision
Incision is taken in the skin
Platysma & superficial fascia dissected
Duct is identified at anterior border of gland
81
82. Cont.
Duct is followed backward through substance
of gland until calculus identified & recovered
Fascial sheath encasing the gland is closed
completely
Wound is closed in layers
Pressure dressing given
82
83. Complete excision of parotid
gland
In this procedure facial nerve preservation is
difficult so this should be explained to the pt
Y-shaped incision is planned, starting from
the superior attachment of the pinna
downward & anteriorly toward angle of the
mandible & anteriorly , forward till hyoid bone
The second arm of incision is made posterior
to the pinna
Ear lobe is retracted upward & skin flap is
developed on the cheek side of the incision
83
84. Cont.
Superficial lobe is freed from its attachments
Stenson’s duct is located , ligated & cut
Deep lobe is approached
Ligation of external carotid artery & posterior
facial vein is carried out
Facial nerve is then carefully elevated from the
deep portion
Deep portion is gently dissected out of the
retromandibular space
Wound is closed in layers
84
85. Excision of submandibular
gland
An incision , 4to5 cm in length , is taken in the
skin in the submandibular region
Incision is placed in, or parallel to the skin
creases , about 2cm below submandibular
border
Wound is deepened through platysma & deep
fascia
Branches of facial nerve in the field are
identified , mobilized & retracted
Facial vein is identified & ligated
85
86. Cont.
Lower pole of the gland is exposed, grasped
with tissue holding forceps
Facial artery is ligated & divided
Gland is separated from lower border of
mandible
Lingual nerve is dissected
Ligature is passed anterior to ductal pathosis
Second ligature is passed posterior to the first
one , but still anterior to the ductal pathosis&
duct is sectioned between the ligatures
86
87. Cont.
Deep part of the gland is excised
Wound sutured in layers
87
88. Complications of surgery of
salivary glands
Damage to lingual nerve
Damage to Wharton's duct
Damage to Auriculotemporal nerve
Facial nerve paralysis
88